I was wondering if someone could confirm the correct way to bill and code for pediatric flu-shots for which patients will be coming in for two separate administrations of the flu vaccine. How do you recommend us billing for this and coding for this? I don't really think that the codes are going to be differant, but my docs are questioning this. Thanks.

I don't think you will get paid twice for the same procedure even though it is done twice becasue you wouldn't normally encounter this situation - you get a flu shot once a year. I'd like to hear some other thoughts.

If the patient is under 9 years old and they have never had a flu shot, they should receive 2 shots, one month apart. There will be two encounters, two vaccines given so, you can bill for the administration and the vaccine both times. We do get reimbursed by insurance for both. Usually for smaller children, insurance does not question because they see that the DOS are one month apart and they have no prior history of flu vaccines... you may receive a denial on an older child (5yr+) but that is easily overturned with a phone call. Hope this helps.

I had the same question myself and was told by our compliance coders to bill for both immunization and administration (either 90657/90658 and 90471) each time. I wasn't sure I agreed w/that, but per others here, sounds like it's worth a shot if we'll get paid for both!

Hi,
I work for an FQHC and wanted to know if we bill and e/m code (99211) and the flu vaccine code and administration code, will we get paid?

Only if 99211 is appropriate, you have to look at the services provided. Read the CPT instructions for the administration code and if your services go beyond that and are documented in the chart you have a case for 99211 but you cannot code it routinely. Services provided must warrant it.

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